ICU · Resuscitation
Source-verified · Sept 2026Fluid therapy and resuscitation fluids in ICU
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Continue reading — 34 referencesMeet the patient
A 72-year-old woman arrives in septic shock from urosepsis. She has received 30 mL/kg of 0.9% saline in the ED — 1.8 L. She remains hypotensive (MAP 59), lactate 3.8, warm peripheries. Her chloride is 112, pH 7.28, base excess minus 6. The registrar wants to give another litre of saline.[14]
Two questions frame every fluid decision in the ICU: which fluid? (balanced crystalloid first-line; saline causes hyperchloraemic acidosis and AKI) and how much? (only about half of ICU patients are fluid responsive — test before every bolus). Get those two right and you avoid the commonest iatrogenic harm in intensive care.[14][15]
References5ShowHide
- [1]Malbrain MLNG, Van Regenmortel N, Saugel B, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy Ann Intensive Care, 2018.PMID 29789983
- [13]Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults N Engl J Med, 2018.PMID 29485925
- [14]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 Intensive Care Med, 2021.PMID 34599691
- [15]Marik PE, Cavallazzi R Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense Crit Care Med, 2013.PMID 23774337
- [21]Myburgh J, Cooper DJ, Finfer S, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury N Engl J Med, 2007.PMID 17761591
